Villiger Anna-Sophie, Fluri Mihaela Madalina, Hoehn Diana, Radan Anda, Kuhn Annette
Department of Obstetrics and Gynecology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland.
J Clin Med. 2024 Oct 14;13(20):6109. doi: 10.3390/jcm13206109.
: The most common variant of mixed urinary incontinence is stress-induced urge urinary incontinence with the correlating urodynamic findings of cough-induced detrusor overactivity (CIDO). This prospective study assessed the clinical outcomes and leakage improvement among patients with CIDO following conservative or surgical treatment. : We included patients with CIDO treated at our tertiary referral center from January 2018 to July 2021 in this prospective cohort study. The detection of a detrusor contraction after a cough was diagnosed as CIDO by urodynamic multichannel testing. All the patients in our study received personalized care, with behavioral therapy and anticholinergic/betamimetic treatment as a first step. If leakage persisted, patients were given a choice between pelvic floor muscle exercises (PFMEs), periurethral bulking or a midurethral sling. The primary outcome was the mean difference in urine leakage in the pad test before and six months after treatment. : Thirty-five patients met the inclusion criteria for CIDO and all presented a positive pad test at baseline (mean: 27 g). All 35 patients participated in behavioral therapy and anticholinergic/betamimetic treatment. Twenty-two patients (62.9%) underwent PFME, twelve patients (34.2%) received periurethral bulking, and nine patients (25.7%) received a midurethral sling. After all the treatments, our cohort showed a significant improvement in the pad test (mean: 5.7 g, < 0.001). The result was more favorable after periurethral bulking than the midurethral sling ( < 0.001). : This study shows the effectiveness of conservative treatment as a first step. In cases needing further treatment, bulking agents may be superior to PFME and midurethral propylene slings, offering new perspectives in the field of urogynecology and urinary incontinence.
混合性尿失禁最常见的类型是压力性诱发急迫性尿失禁，其相关尿动力学表现为咳嗽诱发逼尿肌过度活动（CIDO）。这项前瞻性研究评估了CIDO患者在接受保守治疗或手术治疗后的临床结局及漏尿改善情况。
我们将2018年1月至2021年7月在我们三级转诊中心接受治疗的CIDO患者纳入了这项前瞻性队列研究。通过尿动力学多通道检测，咳嗽后检测到逼尿肌收缩被诊断为CIDO。我们研究中的所有患者均接受个性化护理，第一步是行为疗法和抗胆碱能/β拟交感神经药物治疗。如果漏尿持续存在，患者可在盆底肌锻炼（PFME）、尿道周围填充或中段尿道吊带术之间做出选择。主要结局是治疗前和治疗后6个月垫试验中尿漏的平均差异。
35名患者符合CIDO纳入标准，且在基线时所有患者的垫试验均呈阳性（平均：27克）。所有35名患者均接受了行为疗法和抗胆碱能/β拟交感神经药物治疗。22名患者（62.9%）接受了PFME，12名患者（34.2%）接受了尿道周围填充，9名患者（25.7%）接受了中段尿道吊带术。所有治疗后，我们的队列在垫试验中显示出显著改善（平均：5.7克，<0.001）。尿道周围填充后的结果比中段尿道吊带术更有利（<0.001）。
这项研究表明保守治疗作为第一步是有效的。在需要进一步治疗的情况下，填充剂可能优于PFME和中段尿道聚丙烯吊带，为妇科泌尿学和尿失禁领域提供了新的视角。
